I uppsatsen undersöks hur debatten om ECT konstrueras av de två sociala aktörerna Socialstyrelsen samt Kommittén för Mänskliga Rättigheter, KMR. Det analyserade materialet består av aktörernas publicerade texter på Internet. Kritisk diskursanalys med Norman Faircloughs tredimensionella modell har utgjort studiens ansats. Frågeställningarna har varit; vilka diskurser kan identifieras samt hur kommer dessa till uttryck i ord av de skilda sociala aktörerna involverade i debatten? Hur ser relationerna mellan identifierade diskurser ut? Vilka funktioner fyller de identifierade diskurserna? Analysens mest framträdande resultat påvisar en tydlig medikaliseringsdiskurs samt en antipsykiatrisk diskurs i det empiriska materialet. De sociala aktörerna företräder en förespråkande diskurs respektive en motståndsdiskurs och debatten innebär en hegemonisk kamp omkring behandlingsmetoden ECT och dess legitimitet. Diskussionen mellan parterna förs till stor del genom deras inställning till behandlingen vilken här analyseras diskursivt. / The paper examines how the debate on ECT is constructed by the two social actors Socialstyrelsen (the Swedish social board) and KMR (the Swedish branch of the American association Citizens Commission on Human Rights, CCHR). Analysis material consists of texts published on the Internet by these social actors. The method of analysis used in the essay has been critical discourse analysis, focusing on the three-dimensional model developed by Norman Fairclough. The research questions have been: which discourses can be identified and how are these reflected in the words of the two different social actors involved in the debate? What are the relationships between identified discourses? What features does the identified discourses fill? The most prominent results in the analysis show a clear medicalization discourse and an anti-psychiatry discourse in the empirical material. The social actors represent an advocacy and a resistance discourse, and the debate involves a hegemonic struggle on the treatment method ECT and its legitimacy. The discussions between the parties are to a large extent made out by their approach to treatment which is here analyzed discursively.

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Bakgrund: ECT har funnits inom den psykiatriska vården sedan 40-talet och används fortfarande idag. Behandlingen är vanligast hos patienter med djup depression. Trots att behandlingen är vanlig finns det en begränsad kunskap om patienters erfarenheter inom området.  Sjuksköterskorna ansvarar för omvårdnad och ska identifiera patienternas behov.  Syfte: Syftet är att beskriva erfarenheter av ECT hos patienter som lever med depression. Metod: En kvalitativ innehållsanalys av 12 narrativa texter i form av bloggar har lyfts fram. Resultat: En hoppfullhet finns inför behandlingen, men patienterna är rädda för att biverkningar efteråt ska påverka deras liv negativt. ECT hjälper patienterna att bryta depression, men biverkningar i form av minnesstörningar och kognitiv påverkan förekommer. Patienterna anser att delaktigheten blir lidande då informationen för att kunna ta ett beslut om ECT är bristfällig. Konklusion: Patienterna ser en ljusare framtid då ECT har hjälpt dem att bryta depressionen och lidandet. Patienterna önskar att informationen om ECT:s  risker och biverkningar skulle ha lyfts fram tydligare då biverkningarna påverkar deras liv negativt så som minnesstörningar och kognitiv biverkan. Det är viktigt att sjuksköterskorna samspelar med patienten och gör patienten delaktig i den egna vården för att minska lidandet. / Background: ECT has been a part of psychiatric health care since the 1940’s and is still used today. The treatment is most commonly used with patients suffering from deep depression. Despite the treatment being common, there is little knowledge of the patients’ experiences thereof. The nurses are responsible for the nursing of the patient and for identifying the patients’ needs. Aim: The aim of the study is to describe the experiences of ECT for patients suffering from depression. Method: The study applies a qualitative content analysis in 12 narratives from blogs. Results: Patients are hopeful before the treatment, but at the same time anxious that the treatment will have side effects affecting their lives. ECT helps patients defeat depression, thus sideeffects such as memory disorders and cognitive loss may occur. The patients experience losses in involvement as the information needed to make a decision on ECT is flawed. Conclusion: Patients see a brighter future as ECT has helped them to defeat their depression and suffering. The patients wish that they had been given clearer information regarding the risks and side effects of ECT as the side effects affected their lives. It is therefore important that the nurses cooperate with the patients in order to support their needs and reduce suffering.

nÃo hà / O objetivo principal desta dissertaÃÃo à mostrar as transformaÃÃes estruturais e mercadolÃgicas recÃm sofridas pela ECT, como forma de adequaÃÃo organizacional à conjuntura atual de forte influÃncia da Tecnologia da InformaÃÃo. A abordagem passarà por aspectos conceituais e filosÃficos, por polÃticas governamentais de adequaÃÃo tecnolÃgica do paÃs, chegando Ãs mais recentes alteraÃÃes mercadolÃgicas da ECT, com seus novos serviÃos da CorreiosNet. Ao final, atravÃs de uma anÃlise economÃtrica, buscaremos identificar como alguns fatores se relacionam com a Receita da ECT no perÃodo 2000-2003, e em que nÃvel esta relaÃÃo se dÃ, sobretudo no que se referem aos aportes tecnolÃgicos feitos pela Empresa no perÃodo 2000-2003. Os resultados ressaltam a importÃncia dos capitais humanos de nÃvel bÃsico e tÃcnico na capacidade de prediÃÃo do Modelo. Por outro lado, mostra que os gastos com investimentos em Tecnologia da InformaÃÃo caminharam em sentido oposto ao da Receita, demonstrando que os gastos feitos atà entÃo, ou as estruturas montadas, ainda nÃo atingiram o grau de maturidade necessÃrio. / The main purpose of this work is to show the structural and marketing changes (turnover)experienced by ECT in the past years as a requirement to adjust the organization to the current conjecture of strong influence of the technology of information TI. The discussion will be conducted around conceptual and philosophical aspects, government policies about technological adequacy, and finally discussing about the most recent marketing changes of ECT, along with its new products offered from CorreiosNet. In the end, through a econometrical analysis, we will try to identify some variables that are related with ECTÂs income on the period 2000-2003 and how this variables, especially the TI investment done by the company, are related with the income in the period 2000 2003. The results stands out the importance of the human capitals, of basic level and technicians, in the capacity of predicting the model. On the other hand, it shows that expenditure in investments with TI go in an opposite direction of income, revealing that the expenses made so far on TI and infra-structures, have still not reached the necessary degree of maturity.

Bakgrund: ECT-behandling har länge varit en metod inom psykiatrin och för patienter med svår depression och suicidala tankar. Behandlingsformen har blivit ifrågasatt och stigmatiserad då den ansetts vara barbarisk och likställts med lobotomi. Rädsla hos patienterna har lett till undvikande av behandlingen eller skam efter behandlingen. Författarna upplever det behövas mer forskning inom ämnet ECT för att förbättra förståelsen kring behandlingen, samt förbättra patienternas trygghet inför, under och efter behandlingen. Syfte: Syftet var att beskriva patienters upplevelse av ECT-behandling vid depression. Metod: En kvalitativ litteraturstudie baserad på tio vetenskapliga artiklar utfördes med en induktiv ansats. Analyserades genom metasyntes. Resultat: Analysen resulterade i 3 kategorier: Stigmatiseringen påverkade upplevelsen, Bemötande som hjälpande eller stjälpande, ECT på vinst eller förlust, med tillhörande underkategorier: Fördomar ledde till skam, Rädsla och oro, Hopp och hopplöshet, Otillräcklig information kring behandlingen, Tvång eller otydliga samtycken, Sjuksköterskans bemötande hade betydelse för upplevelsen, Positiva effekter av ECT, Negativa effekter av ECT. Slutsats(er): Resultatet landade i slutsatsen att vikten av adekvat information mellan sjuksköterska och patient är avgörande för att undvika rädsla och oro hos patienten. Behandlingen kan medföra en hel del biverkningar och därför är det extra viktigt med adekvat information om hur behandlingen går till. I sjuksköterskans arbete finns möjligheter till förbättring inom utbildning, bemötande samt informationsutbyte, vilket kan leda till ökad positivitet i upplevelsen av ECT-behandling

Denna uppsats har undersökt hur elektrokonvulsiv terapi (ECT) har gestaltats i de fyra svenska tidningarna Aftonbladet, Dagens Nyheter, Expressen och Svenska Dagbladet mellan åren 1938 och 1989. Detta för att analysera om medias gestaltning av ECT kan ha bidragit till stigmatiseringen av behandlingen och att behandlingen fick ett dåligt rykte under 1960- och 1970-talen och på så vis kan ha påverkat den allmänna opinionen. Detta syfte har preciserats utifrån fyra frågeställningar och uppnås genom att källmaterialet undersöks utifrån en kvalitativ textanalys med kvantitativa inslag. Uppsatsens teoretiska utgångspunkt är gestaltningsteorin. Undersökningen har visat att ECT har gestaltats på olika sätt under den undersökta tidsperioden. Det har skett både en positiv partiskhet som bedöms ha bidragit till att ge ECT ett bra rykte samt en negativ partiskhet som bedöms ha bidragit till att ge ECT ett dåligt rykte och som bedöms ha bidragit till att stigmatisera behandlingen. Det har även visats att det finns likheter mellan medias gestaltning av ECT och medias gestaltning av behandlingen lobotomi. / This essay has examined how electroconvulsice therapy (ECT) has been portrayed in the four Swedish newspapers Aftonbladet, Dagens Nyheter, Expressen and Svenska Dagbladet between the years 1938 and 1989. This has been done to analyze whether the media’s portrayal of ECT may have contributed to the stigmatization of the treatment and to the fact that the treatment gained a bad reputation during the 1960s and 1970s and if the media thus might have influenced the public opinion with its portrayal. The purpose of the essay has been specified by four questions and is achieved by examining the empirical evidence based on a qualitative text analysis with quantitative elements. The theory that is used in this essay is the framing theory, or gestaltningsteorin. The examination has shown that ECT has been portrayed in different ways during the investigated time period. There has been both a posivie bias which has been analyzed to have contributed to giving ECT a good reputation, and a negative bias which has been analyzed to have contributed to giving ECT a bad reputation and to have contributed to the stigmatizing of the treatment. The examination also showed that there are both similarities and differences between the media’s portrayal of ECT and the media’s portrayal of the treatment lobotomy.

Bakgrund: Elektrokonvulsiv terapi har länge varit en behandlingsform inom psykiatrin som främst använts för patienter med förstämningssyndrom. Behandlingen är för många livräddande men påföljderna kan även vara förödande. I samhället finns ett starkt motstånd trots att behandlingen idag är en standardbehandling. Betydelsen av att undersöka patienters upplevelse av ECT är av stor vikt för att minska fördomar och stigmatiseringen gentemot behandlingen. Syfte: Syftet var att beskriva patienters upplevelse av elektrokonvulsiv terapi. Metod: Kvalitativ litteraturöversikt med induktiv ansats där Fribergs analysmodell tillämpades vid dataanalysen. Databaserna Medline och CINAHL användes där 12 resultatartiklar analyserades från årtalen 2003–2023. Resultat: I litteraturöversikten framkom 3 kategorier och 7 underkategorier. Den första kategorin är “De inre känslorna”, som följs av underkategorierna “Skam”, “Oro” och “En sista utväg”. Nästa kategori är “Upplevelse av vården” med underkategorierna “Information” och “Bemötande” och “Beslut om ECT”. Den sista kategorin är “Upplevelse av behandling” som följs av underkategorierna “Positiva upplevelser” och “Negativa upplevelser”. Slutsats: Upplevelsen av ECT kan vara olika där patienten kan uppleva behandlingens effekt som positiv eller negativ, om patienten har känt skam relaterat till behandlingen eller om patienten har känt sig involverad i beslutsprocessen eller ej. Sjuksköterskan kan bidra till förändring i hur samhället betraktar ECT men även aktivt arbeta med utbildning om ECT för att reducera stigmatiseringen. Denna litteraturöversikt kan bidra till att ge sjuksköterskan en djupare förståelse för patienters upplevelse av ECT och reducera stigmatiseringen gentemot behandlingen. / Background: Electroconvulsive therapy has long been a form of treatment in psychiatry mainly used for patients with mood disorders. The treatment is lifesaving for many, but the consequences can also be devastating. There is strong resistance in society, even though the treatment is a standard treatment today. The importance of investigating patients' experience of ECT is of great importance to reduce prejudice and stigma towards the treatment. Purpose: The purpose was to describe patients' experience of electroconvulsive therapy. Method: Qualitative literature review with an inductive approach where Friberg's analysis model was applied to the data analysis. The databases Medline and CINAHL were used where 12 articles were analyzed from the years 2003–2023. Results: In the literature review, 3 categories and 7 subcategories emerged. The first category is “The inner feelings”, which are followed by the subcategories “Shame”, “Anxiety” and “A last resort”. The next category is “Experience of care” with the subcategories “Information” and “Treatment” and “Decision about ECT”. The last category is “Experience of treatment” which is followed by the subcategories “Positive experiences” and “Negative experiences”. Conclusion: The experience of ECT can be different where the patient can experience the effect of the treatment as positive or negative, if the patient has felt shame related to the treatment or if the patient has felt involved in the decision-making process or not. The nurse can contribute to change in how society views ECT but also actively work with education about ECT to reduce the stigma. This literature review can help give the nurse a deeper understanding of patients' experience of ECT and reduce the stigma towards the treatment.

The purpose was to investigate some aspects of epidemiology, risk factors and treatment with ECT in advanced Parkinson’s disease (PD). In study I, we performed a descriptive epidemiologic population-based survey in the Central Health Care District in Östergötland in south-east Sweden, with a population of almost 150,000 inhabitants 1989. The case finding was accomplished in three ways: 1. Collection of all prescriptions for Parkinson’s disease. 2. Search in medical files. 3. Checking with all nursing homes in the area. The crude prevalence was found to be 115 per 100,000 inhabitants. When we used the European Standard Population as a tool for easy comparisons of PD prevalence between different areas and time periods 76 PD-cases per 100,000 inhabitants were found. The corresponding incidences were 11.0 (crude) and 7.9 (age standardised) per 100,000 person-years. Mean age at onset was 65.6. A low prevalence and a high age at onset suggested that e.g. environmental factors could influence the occurrence of PD, and the results implies that only few such factors were present in the investigated area. The findings led to study II, a case-control study which investigated the possible impact of nutritional and environmental risk factors for idiopathic Parkinson’s disease (IP), including 113 cases and 263 control subjects. Dietary, drinking, and smoking habits, as well as previous occupation, were requested in a structured questionnaire. No increased risk was found for any of the nutrients. A reduced risk was found for coffee, wine, and spirits but also for broiled meat, smoked ham or meat, eggs, French loaf or white bread, and tomatoes. These findings could indicate an antioxidant effect. Frequency of preceding and present smoking was reduced in IP patients. Possible mechanisms are discussed. Various occupational groups and exposures were analysed and increased risks of IP in men were found for agricultural work, pesticide exposure, male carpenters, and in female cleaners. In advanced PD there is a need for further therapeutic improvements, and electroconvulsive therapy (ECT) is one insufficiently explored and evaluated method. In study III ECT 16 non-depressed, nondemented PD patients with advanced disease were treated with ECT. In all patients an antiparkinsonian effect of ECT was seen, lasting between a few days and 18 months. Five patients, all with signs of blood brain barrier damage, developed transitory mental confusion after ECT. The results indicated that ECT could cause increased dopaminergic activity, which led us to study IV. Single photon emission computed tomography (SPECT) with the cocaine analogue [123I]-β-CIT was used in order to visualise dopaminergic neurones in the brain. Six patients with PD were examined before and after a series of ECT, and in three cases SPECT was also repeated after one year. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with most pronounced symptomatology. No significant change in uptake of [123I]-β-CIT was seen after ECT, although all patients improved and the most pronounced improvement was seen in patients with less advanced PD. Study V points at two new positive observations with maintenance ECT (MECT). i.e. repeated ECT treatment of PD. One patient had either severe mental side effects on higher L-dopa doses or intolerable parkinsonian symptoms on lower doses. MECT implied marked improvement in parkinsonian symptoms without mental side effects. Another PD patient, who also had a mental depression, showed slight improvement of motor symptoms on a series of ECT. When treated with MECT further antiparkinsonian effects were seen. / On the day of the public defence the status of the article IV was: Submitted; articel V was: Accepted for publication after revision.

<p>Optical-CT has been shown to be a potentially useful imaging tool for for the two very different spheres of biologists and radiation therapy physicists, but it has yet to live up to that potential. In radiation therapy, researchers have used optical-CT for the readout of 3D dosimeters, but it is yet to be a clinically relevant tool as the technology is too slow to be considered practical. Biologists have used the technique for structural imaging, but have struggled with emission tomography as the reality of photon attenuation for both excitation and emission have made the images quantitatively irrelevant. </p><p><bold>Dosimetry.</bold> The DLOS (Duke Large field of view Optical-CT Scanner) was designed and constructed to make 3D dosimetry utilizing optical-CT a fast and practical tool while maintaining the accuracy of readout of the previous, slower readout technologies. Upon construction/optimization/implementation of several components including a diffuser, band pass filter, registration mount & fluid filtration system the dosimetry system provides high quality data comparable to or exceeding that of commercial products. In addition, a stray light correction algorithm was tested and implemented. The DLOS in combination with the 3D dosimeter it was designed for, PREAGETM, then underwent rigorous commissioning and benchmarking tests validating its performance against gold standard data including a set of 6 irradiations. </p><p>DLOS commissioning tests resulted in sub-mm isotropic spatial resolution (MTF >0.5 for frequencies of 1.5lp/mm) and a dynamic range of ~60dB . Flood field uniformity was 10% and stable after 45minutes. Stray light proved to be small, due to telecentricity, but even the residual can be removed through deconvolution. Benchmarking tests showed the mean 3D passing gamma rate (3%, 3mm, 5% dose threshold) over the 6 benchmark data sets was 97.3% ± 0.6% (range 96%-98%) scans totaling ~10 minutes, indicating excellent ability to perform 3D dosimetry while improving the speed of readout. Noise was low at ~2% for 2mm reconstructions. The DLOS/PRESAGE® benchmark tests show consistently excellent performance, with very good agreement to simple known distributions. The telecentric design was critical to enabling fast (~15mins) imaging with minimal stray light artifacts. The system produces accurate isotropic 2mm3 dose data over clinical volumes (e.g. 16cm diameter phantoms, 12 cm height), and represents a uniquely useful and versatile new tool for commissioning complex radiotherapy techniques. The system also has wide versatility, and has successfully been used in preliminary tests with protons and with kV irradiations.</p><p><bold>Biology.</bold> Attenuation corrections for optical-emission-CT were done by modeling physical parameters in the imaging setup within the framework of an ordered subset expectation maximum (OSEM) iterative reconstruction algorithm. This process has a well documented history in single photon emission computed tomography (SPECT), but is inherently simpler due to the lack of excitation photons to account for. Excitation source strength distribution, excitation and emission attenuation were modeled. The accuracy of the correction was investigated by imaging phantoms containing known distributions of attenuation and fluorophores. The correction was validated on a manufactured phantom designed to give uniform emission in a central cuboidal region and later applied to a cleared mouse brain with GFP (green-fluorescent-protein) labeled vasculature and a cleared 4T1 xenograft flank tumor with constitutive RFP (red-fluorescent-protein). Reconstructions were compared to corresponding slices imaged with a fluorescent dissection microscope. </p><p>Significant optical-ECT attenuation artifacts were observed in the uncorrected phantom images and appeared up to 80% less intense than the verification image in the central region. The corrected phantom images showed excellent agreement with the verification image with only slight variations. The corrected tissue sample reconstructions showed general agreement between the verification images. Comprehensive modeling in optical-ECT imaging was successfully implemented, creating quantitatively accurate 3D fluorophore distributions. This work represents the 1st successful attempt encompassing such a complete set of corrections. This method provides a means to accurately obtain 3D fluorophore distributions with the potential to better understand tumor biology and treatment responses.</p> / Dissertation

BACKGROUND: Electroconvulsive therapy (ECT) is an effective intervention for major depressive disorder, especially for subsets of depression that resist more common therapies. However, ECT use is limited by its significant risk for adverse cognitive side effects. Shortening the pulse width of the current used has been demonstrated to lower this risk; however, the shorter pulse may not sufficiently elicit therapeutic effects. A systematic review was performed to determine if UBP ECT is as efficacious as BP ECT, and therefore would be a valid treatment for managing depression. METHODS: We conducted a literature search of MedLine/PubMed, Embase, Cochrane CENTRAL, and Google Scholars databases in October 2017 with the terms “depression”, “major depressive disorder”, “electroconvulsive therapy”, “ECT”, “brief”, “ultrabrief”, and “sine wave”. Studies were selected using inclusion criteria and exclusion criteria. Effects sizes were calculated from formalized mood rating pre-ECT and post-ECT, response rates and remission rates. Heterogeneity and reporting bias of the articles were also assessed. Data were analyzed using meta-analysis tools provided by the Erasmus Research Institute of Management. RESULTS: Data from 9 studies resulted in a pooled Cohen’s d = 0.16 (CI = -0.08 to 0.43, p = 0.149). The effect size alone favors BP ECT over UBP ECT in improving mood as per MADRS/HRSD ratings, but if given p > 0.05, results were non-significant. BP ECT was determined to be more efficacious then UBP ECT in terms of both achieving response and achieving remission, with a pooled ORresponse = 0.72 (CI – 0.49 to 1.05, p = 0.027) and pooled ORremission = 0.65 (CI = 0.42 to 0.98, p = 0.011). CONCLUSION: The choice to use BP ECT or UBP ECT is a balance between the burden of side effects and efficacy. These data suggest that patients with a lower risk of developing cognitive side effect and/or need urgent intervention receive BP ECT. Conversely, patients with a higher risk of developing adverse cognitive side effects and/or are not in need of urgent intervention may benefit UBP ECT. Additional studies are recommended to confirm these findings and clarify the optimal use of these two modalities of ECT.